Memo

TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to coverage of early intervention services

PURPOSE OR GENERAL IDEA OF BILL: To amend the insurance law to ensure recoupment from commercial insurers for the cost of the Early Intervention program.

SUMMARY OF SPECIFIC PROVISIONS: Section one amends Section 3235-a of the insurance law, as added by section 3 of part C of chapter 1 of the laws of 2002, to prohibit accident and health insurance policies from excluding from coverage services provided under title two-A of article twenty-five of the public health law. Section one amends paragraph (c) of section 3235-a to require that the insurer provide a municipality with information on the extent of benefits available to an insured under the policy upon the insurer's receipt of written notice from the municipality as to its subrogation rights. The section also amends paragraph (d) of Section 3235-a to provide that the individualized family services plan, upon certification by the early intervention official, be deemed to meet any precertification, preauthorization and medical necessity requirements imposed on benefits under the policy. Further, section one adds: paragraph (e) to prohibit insurers from denying claims based on the location where services are provided. the duration of the child's condition or that the child's condition is not likely to improve within a time specified in the policy, the absence of a referral by a primary care provider, or that the provider is a non-participating or non-network provider; subsection (f) to provide that the time of loss for the purposes of filing claims shall be the date of payment to the contractor by the municipality; and subsection (g) to require the insurer to issue payment in the amount of the approved costs for early intervention services.

Section two adds two new subparagraphs to section 2559 of the public health law.

Section three provides the effective date.

JUSTIFICATION: Despite Article 25 of the federal Individuals with Disabilities Education Act (IDEA) which mandates public and private commercial insurance to be maximized in financing early intervention (EI) services, reimbursement from third party payers, other than Medicaid, have been minimal leaving the cost of this entitlement to be paid by state and municipal tax dollars.

In recognition of the need to improve recoupment of insurance monies to help pay for EI, the Third Party Reimbursement Task Force of the New York State Early Invention coordinating council was convened in 1999.

That Task Force examined data on billing and recoupment in 1997 and found that private insurance collection was at a low rate of 9%. An updated survey conducted by the New York State Association of County Health Officials of billing and recoupment in 2000 found that, while the amount billed to insurers had almost doubled, the recoupment rate remained a low 11%.

The Task Force also consulted with experts from Massachusetts, Indiana and Virginia, all states that have included in state law the specific requirements necessary to ensure insurance payments for EI. Experts from these three states indicated that requiring insurers to pay for El services minimally impacted insurance premiums and that insurers may in fact have saved money in the long run due to the therapeutic interventions under EI. Experts from the three states confirmed the Task Force's finding that the single most important factor to improve collections as well as reducing administrative burdens was legislation requiring private commercial insurers to pay for EI.

Current insurance law does not include the necessary language to insure that payments are made nor does the language preclude the majority of reasons given for ET denials. As a result, it is necessary that specific language be adopted to fix this problem.

PRIOR LEGISLATIVE HISTORY: A.3719, 2009 and 2010 referred to insurance. A.4399, 2007 and 2008 referred to insurance, A.1014-A, 2005 and 2006 referred to insurance. Same as S.4365-A, 2005 and 2006 referred to insurance. A.6760-A, 2003 and 2004 referred to insurance. Same as S.2410-A 2003 and 2004 referred to insurance. A.11436, 2002 referred to insurance.

New Bill in the Senate

FISCAL IMPLICATIONS: None to the state, savings for municipalities.

EFFECTIVE DATE: This act shall take effect immediately.

Text

STATE OF NEW YORK
________________________________________________________________________
4013--C
2011-2012 Regular Sessions
IN SENATE
March 14, 2011
___________

Introduced by Sen. McDONALD -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the insurance law and the public health law, in relation
to coverage of early intervention services
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subsection (c) of section 3235-a of the insurance law, as
added by section 3 of part C of chapter 1 of the laws of 2002, is
amended and a new subsection (e) is added to read as follows:
(c) Any right of subrogation to benefits which a municipality is enti-
tled in accordance with paragraph (d) of subdivision three of section
twenty-five hundred fifty-nine of the public health law shall be valid
and enforceable to the extent benefits are available under any accident
and health insurance policy. The right of subrogation does not attach to
insurance benefits paid or provided under any accident and health insur-
ance policy prior to receipt by the insurer of written notice from the
municipality. UPON THE INSURER'S RECEIPT OF WRITTEN REQUEST AND NOTICE
FROM THE MUNICIPALITY THAT SUCH RIGHT OF SUBROGATION HAS BEEN GRANTED TO
SUCH MUNICIPALITY AND THAT THE INSURED HAS AUTHORIZED THE RELEASE OF
INFORMATION TO THE MUNICIPALITY, THE INSURER SHALL PROVIDE THE MUNICI-
PALITY WITH INFORMATION ON THE EXTENT OF BENEFITS AVAILABLE TO THE
COVERED PERSON UNDER SUCH POLICY.
(E) WRITTEN CLAIM FOR EARLY INTERVENTION PROGRAM SERVICES SHALL BE
SUBMITTED BY THE MUNICIPALITY AS THE APPROVED PROVIDER WITHIN ONE
HUNDRED FIFTY DAYS FROM THE DATE OF SERVICE.

EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00328-12-1

S. 4013--C 2

S 2. Paragraph (a) of subdivision 3 of section 2559 of the public
health law is amended by adding two new subparagraphs (i) and (ii) to
read as follows:
(I) PARENTS SHALL PROVIDE AND THE MUNICIPALITY SHALL OBTAIN INFORMA-
TION ON ANY PLAN OF INSURANCE UNDER WHICH AN ELIGIBLE CHILD HAS COVER-
AGE.
(II) PARENTS SHALL PROVIDE THE MUNICIPALITY WITH A WRITTEN REFERRAL
FROM A PRIMARY CARE PROVIDER AS DOCUMENTATION, FOR ELIGIBLE CHILDREN, OF
THE MEDICAL NECESSITY OF EARLY INTERVENTION SERVICES.
S 3. This act shall take effect immediately.

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